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The ACR recommends treating gout with ULT if:

1. >=1 tophi (strong recommendation, high moderate evidence)
2. radiographic damage from gout (strong recommendation, high moderate evidence)
3. >=2 flares/year (strong recommendation, high moderate evidence)
4. >1 lifetime flare but <2 /year (conditional recommendation, high moderate evidence)
5. first flare and CKD stage ~3, SU >535 umol/L, or urolithiasis (Conditional recommendation, very low evidence)

► Allopurinol is recommended as first line, starting ~100mg/d and titrating (treat to target based on serum urate <360 umol/L) and should be continued indefinitely

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The Compendium platform was created by David Kwinter, MD, CCFP(EM).